TY - JOUR
T1 - Patients originally diagnosed with idiopathic atrial fibrillation more often suffer from insidious coronary artery disease compared to healthy sinus rhythm controls
AU - Weijs, Bob
AU - Pisters, Ron
AU - Haest, Rutger J.
AU - Kragten, Johannes A.
AU - Joosen, Ivo A.
AU - Versteylen, Mathijs
AU - Timmermans, Carl C.
AU - Pison, Laurent
AU - Blaauw, Yuri
AU - Hofstra, Leonard
AU - Nieuwlaat, Robby
AU - Wildberger, Joachim
AU - Crijns, Harry J.
PY - 2012/12
Y1 - 2012/12
N2 - BACKGROUND Idiopathic atrial fibrillation (AF) refers to a clinically lacking cardiovascular or pulmonary disease generating the pathophysiologic substrate for the arrhythmia. However, because idiopathic AF is associated with an increased event rate, it could be a harbinger of as-yet undetected underlying heart disease. OBJECTIVE The purpose of this study was to determine the prevalence of coronary artery disease (CAD) in patients diagnosed with idiopathic paroxysmal AF. METHODS Of the 3243 patients who underwent cardiac computed tomographic angiography (CTA) in our center between January 2008 and March 2011, we identified a total of 115 consecutive idiopathic paroxysmal AF patients who underwent CTA before electrophysiologic ablation. Patients were compared with 275 age-, sex-, and PROCAM risk score-matched healthy controls in permanent sinus rhythm. All patients were free of hypertension, diabetes, congestive heart failure, previous known coronary artery and peripheral vascular disease, previous stroke, thyroid, pulmonary, and renal disease, and structural abnormalities on echocardiography. RESULTS Controls more often showed a family history of CAD (38% vs 15%, P <.001), had a higher prevalence of smoking (25% vs 14%, P = .021), higher fasting blood glucose levels (5.5 +/- 0.7 mmol/L vs 5.4 +/- 0.6 mmol/L, P = .025), and smaller atrial diameters (37 +/- 4 mm vs 40 +/- 5 mm, P <.001) compared to AF patients. Notwith-standing the above, idiopathic AF patients significantly more often suffered from subclinical CAD compared to controls (49% vs 34%, P = .008). Multivariable regression analysis revealed that beside (as expected) age and gender, a history of AF and left atrial diameter were significant predictors of underlying CAD. CONCLUSION Half of patients originally diagnosed with idiopathic paroxysmal AF show concealed underlying CAD. The detection and treatment of CAD at an early stage could improve the prognosis of these patients.
AB - BACKGROUND Idiopathic atrial fibrillation (AF) refers to a clinically lacking cardiovascular or pulmonary disease generating the pathophysiologic substrate for the arrhythmia. However, because idiopathic AF is associated with an increased event rate, it could be a harbinger of as-yet undetected underlying heart disease. OBJECTIVE The purpose of this study was to determine the prevalence of coronary artery disease (CAD) in patients diagnosed with idiopathic paroxysmal AF. METHODS Of the 3243 patients who underwent cardiac computed tomographic angiography (CTA) in our center between January 2008 and March 2011, we identified a total of 115 consecutive idiopathic paroxysmal AF patients who underwent CTA before electrophysiologic ablation. Patients were compared with 275 age-, sex-, and PROCAM risk score-matched healthy controls in permanent sinus rhythm. All patients were free of hypertension, diabetes, congestive heart failure, previous known coronary artery and peripheral vascular disease, previous stroke, thyroid, pulmonary, and renal disease, and structural abnormalities on echocardiography. RESULTS Controls more often showed a family history of CAD (38% vs 15%, P <.001), had a higher prevalence of smoking (25% vs 14%, P = .021), higher fasting blood glucose levels (5.5 +/- 0.7 mmol/L vs 5.4 +/- 0.6 mmol/L, P = .025), and smaller atrial diameters (37 +/- 4 mm vs 40 +/- 5 mm, P <.001) compared to AF patients. Notwith-standing the above, idiopathic AF patients significantly more often suffered from subclinical CAD compared to controls (49% vs 34%, P = .008). Multivariable regression analysis revealed that beside (as expected) age and gender, a history of AF and left atrial diameter were significant predictors of underlying CAD. CONCLUSION Half of patients originally diagnosed with idiopathic paroxysmal AF show concealed underlying CAD. The detection and treatment of CAD at an early stage could improve the prognosis of these patients.
KW - Cardiac computed tomographic angiography
KW - Coronary artery disease
KW - Idiopathic atrial fibrillation
U2 - 10.1016/j.hrthm.2012.08.013
DO - 10.1016/j.hrthm.2012.08.013
M3 - Article
SN - 1547-5271
VL - 9
SP - 1923
EP - 1929
JO - Heart Rhythm
JF - Heart Rhythm
IS - 12
ER -